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European Heart Journal Advance Access originally published online on June 22, 2007
European Heart Journal 2007 28(17):2057-2063; doi:10.1093/eurheartj/ehm191
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Percutaneous left ventricular assist devices in acute myocardial infarction complicated by cardiogenic shock

Holger Thiele1,*, Richard W. Smalling2 and Gerhard C. Schuler1

1 Department of Internal Medicine/Cardiology, University of Leipzig—Heart Center, Strümpellstr. 39, 04289 Leipzig, Germany
2 Division of Cardiovascular Medicine, Department of Internal Medicine, The Memorial Hermann Heart and Vascular Institute, University of Texas, Houston, TX, USA

Received 8 November 2006; revised 4 April 2007; accepted 13 April 2007; online publish-ahead-of-print 22 July 2007.

* Corresponding author. Tel: +49 341 8651426/1428; fax: +49 341 865 1461. E-mail address: thielh{at}medizin.uni-leipzig.de


   Abstract
Top
 Abstract
Introduction
 Percutaneous cardiopulmonary...
 Axial flow pumps
 Left atrial-to-femoral arterial...
 Conclusions
 References
 
Cardiogenic shock (CS) remains the most common cause of death in patients with acute myocardial infarction (AMI). In addition to percutaneous coronary intervention, inotropes, and fluids, intraaortic balloon pumping (IABP) is most widely used for initial haemodynamic stabilization. However, the main limitation of IABP is the lack of active circulatory support and the requirement of a certain level of left ventricular (LV) function. In many patients with severe depression of LV function, haemodynamic support and LV unloading derived from IABP is insufficient to reverse CS. The use of percutaneous LV assist devices (LVAD) with active circulatory support might be beneficial in CS patients not responding to standard treatment including IABP support. This review reports the current experience of percutaneous LVAD in CS complicating AMI.

Key Words: Shock • Heart-assist device • Heart failure • Haemodynamics • Myocardial infarction


   Introduction
Top
 Abstract
 Introduction
Percutaneous cardiopulmonary...
 Axial flow pumps
 Left atrial-to-femoral arterial...
 Conclusions
 References
 
The incidence of cardiogenic shock (CS) in patients with AMI ranges from 7 to 10% after acute myocardial infarction (AMI).1,2 Despite aggressive treatment modalities such as percutaneous coronary interventions (PCI) and use of intraaortic balloon support, mortality of CS remains unacceptably high (50–70%).1,3,4 Recovery of myocardial performance following successful revascularization of the infarct related artery may require several days. During this period many patients succumb to low cardiac output. Therefore, intraaortic balloon pumping (IABP) is the method of choice for mechanical assistance,5 since IABP can result in initial haemodynamic stabilization.6–8 Systematic reviews on the mode of action, physiological response and clinical studies have been published elsewhere.9,10 The main limitations of IABP include the lack of active cardiac support, need for accurate synchronization with the cardiac cycle, and requirement of a certain level of left ventricular (LV) function. In many patients with severe depression of cardiac function or persistent tachyarrhythmias, haemodynamic support and LV unloading derived from IABP are insufficient to reverse CS.11

Therefore, the use of percutaneous LV assist devices (LVAD) with active circulatory support might be beneficial in patients with CS not responding to standard treatment, although this is currently not supported by randomized controlled clinical data (Figure 1). Usually these devices are used as a bridge-to-recovery, which may last several days. In patients with mechanical complications after AMI, LVAD are used as a bridge-to-surgery, or in patients without recovery, the surgical implantation of a long-term LVAD,12,13 or emergent heart transplantation might be necessary (Figure 1). Therefore, percutaneous LVAD are usually designed for a maximum use of 14 days.


Figure 1
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  		Figure 1 Possible scheme for selection of patients with cardiogenic shock complicating acute myocardial infarction for implantation of left ventricular assist devices (not supported by randomized controlled trials).

 
Currently, there are several different devices and modes of operation.


   Percutaneous cardiopulmonary bypass
Top
 Abstract
 Introduction
 Percutaneous cardiopulmonary...
Axial flow pumps
 Left atrial-to-femoral arterial...
 Conclusions
 References
 
After introduction of the first cardiopulmonary bypass (CPB) system with oxygenation in 1953, further developments led to percutaneously implantable devices.14 Such systems consist mainly of a blood pump and an oxygenator; 16–18 French arterial cannulae in the descending aorta and 18 French venous cannula advanced into the right atrium are used (Figure 2). These cannulae are connected to an external pump and a membrane oxygenator. After pump priming with normal saline, blood is withdrawn from the right atrium and pumped through a heat exchanger, membrane oxygenator, and ultimately returned into the femoral artery. The pump provides a continuous flow with maintenance of a pulsatile arterial pressure unless the circulation is completely supported by the CPB device. There are several drawbacks of CPB such as large cannulae sizes with subsequent lower limb ischaemic complications, requirement of perfusionists, lack of direct LV unloading, increased afterload, and a limited support time (usually <6 h).15 Therefore, percutaneous CBP has mainly been used for patients with cardiopulmonary collapse in the cath lab. Those patients with abrupt closure of a vessel may be supported until the situation is resolved by either PCI or until transfer in a stable condition to the operating room for emergency cardiac surgery. Since the introduction of a percutaneous approach, >200 patients have been treated during resuscitation efforts or in acute severe CS.14,16–23 The survival rates of these reports range from 4–64% with a mean survival rate of approximately 25%. There are only limited experiences in CS after AMI,24 and for patients with mechanical complications.25


Figure 2
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  		Figure 2 Schematic drawing of the percutaneous cardiopulmonary bypass assist device. Transfemoral venous and arterial cannulae are inserted percutaneously. Blood is pumped from the right atrium via a pump and an oxygenator to the abdominal aorta (reprinted with permission of Scholz).

 
In summary, the percutaneous CPB system has been lifesaving for a small group of patients with abrupt haemodynamic collapse in the cath lab. Its use is limited by high associated complications, need of extracorporeal circulation and a membrane oxygenator with subsequent activation of cellular elements, and limited support time. The clinical impact of new, smaller, and portable devices such as the Lifebridge B2T® needs to be determined in future trials.26


   Axial flow pumps
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 Abstract
 Introduction
 Percutaneous cardiopulmonary...
 Axial flow pumps
Left atrial-to-femoral arterial...
 Conclusions
 References
 
These pumps are usually positioned across the aortic valve to provide active support by transvalvular LV assistance (Figure 3). In 1988, Wampler et al.27 were the first to describe an axial, catheter-mounted LVAD inserted by surgical arteriotomy via the femoral artery. The outer diameter was 21 French and the length 26 cm. The axial flow pump consisted of a disposable suction cannula with a turbine driven by an external motor (Figure 4). The pumping system consisted of an axial flow blood pump, which was positioned in the aortic arch or the descending aorta, an inlet cannula, and a drive cable in a polymeric sheath and a motor. Depending on the aortic pressure, the pump capacity was up to 3.5 L/min at a speed of 25 000 r.p.m. In a canine infarct model, the effects of LV unloading were assessed. Treatment with the HemopumpTM (Medtronic Inc., Minneapolis, MN, USA) resulted in significant myocardial salvage as compared with reperfusion alone.28 In addition, it provided superior LV unloading in comparison to IABP.28 Similar positive results on LV unloading, myocardial perfusion pressure, and serum lactate levels were obtained in a sheep model.29,30


Figure 3
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  		Figure 3 Axial flow pump positioned across the aortic valve into the left ventricle.

 

Figure 4
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  		Figure 4 Schematic drawing of the 21 French HemopumpTM. The axial pump is fixed at the distal part of a flexible silicone suction cannula, which is positioned retrogradely across the aortic valve into the left ventricle. The pump outlet is located in the aortic arch or in the descending aorta (reprinted with permission of Scholz).

 
In a subsequent small pilot study, the 21 French HemopumpTM was used in 11 patients with CS after AMI.31 Haemodynamic parameters and catecholamine requirements improved significantly during the initial 24 h of haemodynamic support. Overall mortality in this trial was 64%.31 However, a transfemoral placement of the pump via the aortic valve was possible in only two thirds of the patients despite surgical cutdown of the femoral artery. In another multiinstitutional study including patients with CS, the insertion rate of this LVAD was 77%; 30-day-mortality was 68%.32

A smaller 14 French HemopumpTM (Medtronic Inc.) was devised that could be inserted percutaneously.33 At a speed of 40 000 r.p.m. the system delivered flow of up to 2.2 L/min. In a multicentre registry of the percutaneous HemopumpTM during high-risk PCI, the overall mortality was 12.5% for 32 patients not in CS.34 In addition, despite the short-term use, there were significant procedure and device-related vascular access problems (16% limb ischaemia, 25% bleeding complications).34 As a cause of the high complication rate, the HemopumpTM never received FDA approval and further development was not pursued.

Recently, new axial flow devices have been developed. The Impella Recover® LP 5.0 (Impella CardioSystems GmbH, Aachen, Germany) axial flow pump is a microaxial flow pump capable of delivering a continuous flow of up to 5 L/min (Table 1), which is also available as a surgical insertion LVAD.35,36 By use of this device in a sheep infarction model, oxygen consumption was reduced during ischaemia and led to infarct size reduction.37 A drawback was the requirement of femoral artery surgical cutdown.38 However, in comparison to the Hemopump, positioning across the aortic valve appears to be successful in a higher proportion of patients as a guidewire can be positioned across the device tip. Currently, the Impella Recover® LP 5.0 has been used in approximately 200 cases, is under investigational use in a FDA approval study, and has received CE mark for use in Europe.


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  		Table 1 Technical features of currently available percutaneous left ventricular assist devices for haemodynamic support in the cath lab

 
A smaller device, the Impella Recover LP® 2.5 approved for 5 day use in Europe, can be inserted percutaneously and provides continuous flow up to 2.5 L/min (Table 1). The device is equipped with a pigtail-catheter at the tip to ensure stable positioning in the LV and to prevent it from adhering to the myocardium (Figure 3). So far, there is only limited clinical experience, in particular in stable patients with high-risk PCI, and it remains unclear if 2.5 L/min is adequate to reverse CS.39

Limitations of axial support devices are related to the position in the aortic valve. The presence of a mechanical aortic valve or an aortic stenosis is a contraindication for the implantation. Furthermore, these devices might be inefficient in severe aortic regurgitation, and some need surgical cutdown of the femoral artery. Due to the high rotation speed of the impeller, these devices might provoke significant haemolysis.38


   Left atrial-to-femoral arterial left ventricular assist devices
Top
 Abstract
 Introduction
 Percutaneous cardiopulmonary...
 Axial flow pumps
 Left atrial-to-femoral arterial...
Conclusions
 References
 
In 1962, this system was first described by the jugular approach.40 Initially, left atrial-to-femoral arterial LVAD were used in patients not weanable from CPB after cardiothoracic surgery.41 Subsequently, percutaneous approaches for patients undergoing high-risk interventions for short-term use have been reported.42 Due to the lack of a transseptal cannula that can accommodate flow rates necessary to provide adequate circulatory support, due to risk of thrombus formation at the impeller, and due to inherent haemolysis of high-speed centrifugal pumps, this technique has not achieved widespread popularity. Therefore, new developments have been made to avoid the inherent risk of thrombus formation and haemolysis by centrifugal pumps.

The Tandem HeartTM pVAD (Cardiac Assist Technologies, Inc., Pittsburgh, PA, USA), which is approved for short-term haemodynamic support (6 h) by the FDA and which is currently marketed in the USA and Europe, is a new generation low speed centrifugal continuous flow pump with a low blood surface contact area resulting in reduced potential for haemolysis and thromboemboli. The implantation procedure has been described in detail elsewhere.43 In brief, after standard transseptal puncture and pre-dilatation of the fossa ovalis, a venous inflow cannula is inserted into the left atrium (Figure 5). Afterwards an arterial cannula (usually 17 French) needs to be inserted into the femoral artery. Once all air has been removed from the system, the cannulae are connected to the extracorporeal centrifugal pump by standard tygon tubing. Oxygenated blood is drawn from the left atrium and returned via the centrifugal pump and via the arterial cannula in the femoral artery to the lower abdominal aorta (Figure 5). After a short learning curve this device can be inserted and LV assist instituted in <30 min in the cath lab setting. The system is capable of delivering flow up to 4.0 L/min at 7500 r.p.m. In a feasibility trial, 18 patients with CS were enrolled.43 With the device, CS could be reversed efficiently as monitored by haemodynamic and metabolic parameters, and the overall mortality rate was as low as 44%.43 In a subsequent randomized trial comparing the Tandem HeartTM and IABP in 41 patients with revascularized AMI complicated by CS, the device was able to improve the haemodynamic and metabolic variables more effectively than with IABP support.44 However, complications like severe bleeding, limb ischaemia, or fever were encountered more frequently after LVAD support, whereas the 30-day-mortality was similar (IABP 45% vs. LVAD 42%, log-rank, P = 0.86).44 Similar results with increased complications without a significant mortality benefit were obtained in a second multicentre trial of the Tandem HeartTM in comparison to IABP for CS.45 The most important drawback of the left atrial-to-femoral-arterial bypass support is the need for large arterial cannulae to achieve the required flow. Furthermore, currently little is known about the fate of the transseptal puncture site. However, in recent series, no relevant left-to-right shunt has been observed by careful echocardiographic monitoring.43,44,46


Figure 5
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  		Figure 5 Diagram of the percutaneously inserted transseptal and arterial cannulae connected to the Tandem HeartTM centrifugal pump. Right upper corner: close-up of the transseptal catheter with large end hole and 14 side holes in the left atrium.

 
An overview of the technical features of currently available LVAD for percutaneous support or those that can be inserted by peripheral surgical cutdown is shown in Table 1.

Effects of left ventricular unloading
Besides the haemodynamic effects of an active LVAD in comparison to IABP support, the recovery of the myocardium after revascularization occurs by a reduction of the LV filling pressure, cardiac workload, and oxygen demand. Previous animal studies have demonstrated a substantial decrease in infarct size by use of CPB with venting of the LV and by axial and left atrial-to-femoral LVAD with or without revascularization of the infarct related artery.28,37,47–52 Furthermore, in animal models, LV unloading prior to revascularization of the infarcted artery led to significant myocardial salvage in comparison to the implementation of unloading after reperfusion.50,53 A clinical trial supporting this hypothesis is still pending.

In patients with end-stage heart failure, long-term implantable LVAD were useful in improving symptoms and in preventing or reversing heart failure by inducing neuroendocrine modulation and reverse remodelling. In terms of neurohormonal modulation, LVAD support decreased plasma levels of epinephrine, norepinephrine, angiotensin II, and arginine vasopressin.54 Furthermore, serum levels of interleukins 6 and 8 and TNF-{alpha} content in the failing myocardium could be reduced.12,55 In terms of remodelling, long-term LVAD support has been shown to significantly reduce collagen content and decrease myocyte size.56 In addition, improvement in myocyte contractility and myocardial response to β-adrenergic stimulation has been observed.57 However, whether these neuroendocrine and reverse remodelling effects can be translated into the acutely failing heart in patients with CS after AMI with short-term assisted circulatory support is not known.

Limitations
As all percutaneous implantable LVAD provide continuous flow, this also affects the flow in the coronary arteries, which leads to non-physiological flow. The debate regarding the effect of non-pulsatile flow on organ function and the hormonal situation is extensive and remains controversial and has not been finally determined.58–60

Active circulatory support LVAD have been used so far only in small trials with limited number of patients enrolled. Except the two randomized Tandem HeartTM vs. IABP trials, there are no randomized trials that have proven a substantial benefit of these devices over standard treatment.44,45 Although the haemodynamic effects of active support LVAD have been proven in several trials, there is no trial that had the power to detect differences in mortality. A large clinical trial, supporting the theoretical advantages of an active LVAD (in particular in patients with a significant amount of stunned myocardium not responding to standard treatment) is warranted; however, currently there is no larger trial on the horizon. In addition, there are no trials assessing the merits of risks of each LVAD against the other. Therefore, no conclusion can be drawn regarding the different risk of embolic complication, haemolysis, inducement of aortic regurgitation, or the dislodgment risk from the optimal site in the left atrium or LV.

There are new hypotheses that in the development and maintenance of CS peripheral factors play an important role besides extensive myocardial necrosis.61 Theoretically, extracorporeal support and contact with artificial surfaces of LVAD might further promote the systemic inflammatory response syndrome with subsequent deterioration to a multiorgan dysfunction syndrome. A second, potentially deleterious effect of extracorporeal circulation, besides the propagation of systemic inflammatory response, is the activation of complement and the development of coagulation with subsequent fibrinolysis, which may progress to disseminated intravascular coagulation leading to severe bleeding complications.62,63

Furthermore, these devices are expensive in comparison to standard IABP treatment resulting in up to 30-fold higher costs (Table 1). In view of these limitations, there are some general contraindications for LVAD in addition to specific contraindications of the different systems, such as contraindication to anticoagulation, severe aortic regurgitation, terminal disease with limited life expectancy, advanced multiorgan dysfunction syndrome, central nervous system injury, right ventricular failure, severe bleeding, sepsis, uncontrolled by antibiotics, and severe peripheral arterial obstructive disease.


   Conclusions
Top
 Abstract
 Introduction
 Percutaneous cardiopulmonary...
 Axial flow pumps
 Left atrial-to-femoral arterial...
 Conclusions
References
 
LVAD with active circulatory support reverse haemodynamic and metabolic parameters in CS more effectively than with standard IABP treatment alone. The use of these newer percutaneous devices is still in its infancy. The easier and safer deployment of the newly developed devices may increase their use for patients not responding to PCI, fluids, inotropes, and IABP. Although, from a theoretical point of view, these active LVAD might be beneficial, it remains to be proven that these actually alter the high mortality of CS patients. Furthermore, these devices are associated with more complications as a result of the highly invasive procedure and the extracorporeal support in some of these devices. Therefore, the decision making process on how to treat CS complicating AMI in addition to standard treatment requires an integrated stepwise approach, although the evidence supporting this is very limited. An LVAD might be considered on the basis of individual risk, success rates of standard treatment, and potential periprocedural event rates.

Conflict of interest: none declared.


   References
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 Abstract
 Introduction
 Percutaneous cardiopulmonary...
 Axial flow pumps
 Left atrial-to-femoral arterial...
 Conclusions
 References
 

  1. Goldberg RJ, Samad NA, Yarzebski J, Gurwitz J, Bigelow C, Gore JM. Temporal trends in cardiogenic shock complicating acute myocardial infarction. N Engl J Med (1999) 340:1162–1168.[Abstract/Free Full Text]
  2. Holmes DR Jr, Bates ER, Kleiman NS, Sadowski Z, Horgan JH, Morris DC, Califf RM, Berger PB, Topol EJ. Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-I trial experience. The GUSTO-I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. J Am Coll Cardiol (1995) 26:668–674.[Abstract]
  3. Barron HV, Every NR, Parsons LS, Angeja B, Goldberg RJ, Gore JM, Chou TM. The use of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction: data from the National Registry of Myocardial Infarction 2. Am Heart J (2001) 141:933–939.[CrossRef][ISI][Medline]
  4. Hochman JS, Buller CE, Sleeper LA, Boland J, Dzavik V, Sanborn TA, Godfrey E, White HD, Lim J, LeJemtel T. Cardiogenic shock complicating acute myocardial infarction—etiologies, management and outcome: A report from the SHOCK trial registry. J Am Coll Cardiol (2000) 36:1063–1070.[Abstract/Free Full Text]
  5. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction—executive summary. Circulation (2004) 110:588–636.[Free Full Text]
  6. Thiele H, Lauer B, Hambrecht R, Boudriot E, Sick P, Niebauer J, Falk V, Schuler G. Short- and long-term hemodynamic effects of intra-aortic balloon support in ventricular septal defect complicating acute myocardial infarction. Am J Cardiol (2003) 92:450–454.[CrossRef][ISI][Medline]
  7. Scheidt S, Wilner G, Mueller H, Summers D, Lesch M, Wolff G, Krakauer J, Rubenfire M, Fleming P, Noon G, Oldham N, Killip T, Kantrowitz A. Intra-aortic balloon counterpulsation in cardiogenic shock. Report of a co-operative clinical trial. N Engl J Med (1973) 288:979–984.[ISI][Medline]
  8. DeWood MA, Notske RN, Hensley GR, Shields JP, O'Grady WP, Spores J, Goldman M, Ganji JH. Intraaortic balloon counterpulsation with and without reperfusion for myocardial infarction shock. Circulation (1980) 61:1105–1112.[Abstract/Free Full Text]
  9. Santa-Cruz RA, Cohen MG, Ohman EM. Aortic counterpulsation: a review of the hemodynamic effects and indications for use. Cath Cardiovasc Inter (2006) 67:68–77.[CrossRef]
  10. Bates ER, Stomel RJ, Hochman JS, Ohman EM. The use of intraaortic balloon counterpulsation as an adjunct to reperfusion therapy in cardiogenic shock. Int J Cardiol (1998) 65(Suppl. 1):S37–S42.[CrossRef][ISI][Medline]
  11. Pae WE Jr, Pierce WS. Temporary left ventricular assistance in acute myocardial infarction and cardiogenic shock: rationale and criteria for utilization. Chest (1981) 79:692–695.[CrossRef][ISI][Medline]
  12. Goldstein DJ, Oz MC, Rose EA. Implantable left ventricular assist devices. N Engl J Med (1998) 339:1522–1533.[Free Full Text]
  13. Delgado DH, Rao V, Ross HJ, Verma S, Smedira NG. Mechanical circulatory assistance. State of art. Circulation (2002) 106:2046–2050.[Free Full Text]
  14. Phillips SJ, Ballentine B, Slonine D, Hall J, Vandehaar J, Kongtahworn C, Zeff RH, Skinner JR, Reckmo K, Gray D. Percutaneous initiation of cardiopulmonary bypass. Ann Thorac Surg (1983) 36:223–225.[Abstract]
  15. Scholz KH. Reperfusion therapy and mechanical circulatory support in patients in cardiogenic shock. Herz (1999) 24:448–464.[ISI][Medline]
  16. Zeymer U, Reissig M, Neuhaus KL. The use of a percutaneously connected heart–lung machine during resuscitation in cardiogenic shock after acute myocardial infarct. Dtsch Med Wochenschr (1993) 118:1755–1758.[Medline]
  17. Shawl FA, Domanski MJ, Wish MH, Davies M, Punja S, Hernandez TJ. Emergency cardiopulmonary bypass support in patients with cardiac arrest in the catheterization laboratory. Cathet Cardiovasc Diagn (1990) 19:8–12.[ISI][Medline]
  18. Reedy JE, Swartz MT, Raithel SC, Szukalski EA, Pennington DG. Mechanical cardiopulmonary support for refractory cardiogenic shock. Heart Lung (1990) 19:514–523.[ISI][Medline]
  19. Raithel SC, Swartz MT, Braun PR, Dake SB, Taub JO, Zambie MA, Miller LW, Deligonul U, McBride LR, Pennington DG. Experience with an emergency resuscitation system. Trans ASAIO (1989) 35:475–477.[Medline]
  20. Reichman RT, Joyo CI, Dembitsky WP, Griffith LD, Adamson RM, Daily PO, Overlie PO, Smith SC, Jaski BE. Improved patient survival after cardiac arrest using a cardiopulmonary support system. Ann Thorac Surg (1990) 49:101–104.[Abstract]
  21. Overlie PA, Walter PD, Hurd HP, Wells GA, Seger JJ, Zias J, Wey RJ, Jensen JB, Shoukfeh MF, Levine MJ. Emergency cardiopulmonary support with circulatory support devices. Cardiology (1994) 84:231–237.[ISI][Medline]
  22. Mooney MR, Arom KV, Joyce LD, Mooney JF, Goldenberg IF, Von Rueden TJ, Emery RW. Emergency cardiopulmonary bypass support in patients with cardiac arrest. J Thorac Cardiovasc Surg (1991) 101:450–454.[Abstract]
  23. Hartz R, LoCicero J, Sanders JH, Frederiksen JW, Joob AW, Michaelis LL. Clinical experience with portable cardiopulmonary bypass in cardiac arrest patients. Ann Thorac Surg (1990) 50:437–441.[Abstract]
  24. Shawl FA, Domanski MJ, Hernandez TJ, Punja S. Emergency percutaneous cardiopulmonary bypass support in cardiogenic shock from acute myocardial infarction. Am J Cardiol (1989) 64:967–970.[CrossRef][ISI][Medline]
  25. Fujimoto K, Kawahito K, Yamaguchi A, Sakuragawa H, Tsuboi J, Yuri K, Tanaka M, Endo H, Adachi H, Ino T. Percutanous extracorporeal life support for treatment of fatal mechanical complications associated with acute myocardial infarction. Artif Organs (2001) 25:1000–1003.[CrossRef][ISI][Medline]
  26. Mehlhorn U, Brieske M, Fischer UM, Ferrari M, Brass P, Fischer JH, Zerkowski HR. LIFEBRIDGE: a portable, modular, rapidly available ‘plug-and-play’ mechanical circulatory support system. Ann Thorac Surg (2005) 80:1887–1892.[Abstract/Free Full Text]
  27. Wampler RK, Moise JC, Frazier OH, Olsen DB. In vivo evaluation of a peripheral vascular access axial flow blood pump. Trans ASAIO (1988) 34:450–454.[Medline]
  28. Smalling RW, Cassidy DB, Barrett R, Lachterman B, Felli P, Amirian J. Improved regional myocardial blood flow, left ventricular unloading, and infarct salvage using an axial-flow, transvalvular left ventricular assist device. A comparison with intra-aortic balloon counterpulsation and reperfusion alone in a canine infarction model. Circulation (1992) 85:1152–1159.[Abstract/Free Full Text]
  29. Scholz KH, Hering JP, Schröder T, Uhlig P, Tebbe U, Kreuzer H, Hellige G. Protective effects of the hemopump left ventricular assist device in experimental cardiogenic shock. Eur J Cardiothorac Surg (1992) 6:209–214.[Abstract]
  30. Hering JP, Schröder T, Uhlig P, Scholz KH, Tebbe U, Kreuzer H, Hellige G. Myocardial support and protection during regional myocardial ischemia using the hemopump assist device. Thorac Cardiovasc Surg (1991) 39:257–262.[ISI][Medline]
  31. Smalling RW, Sweeney M, Lachterman B, Hess MJ, Morris R, Anderson HV, Heibig J, Li G, Willerson JT, Frazier H. Transvalvular left ventricular assistance in cardiogenic shock secondary to acute myocardial infarction. Evidence for recovery from near fatal myocardial stunning. J Am Coll Cardiol (1994) 23:637–644.[Abstract]
  32. Wampler RK, Frazier OH, Lansing AM, Smalling RW, Nicklas JM, Phillips SJ, Guyton RA, Golding LA. Treatment of cardiogenic shock with the Hemopump left ventricular assist device. Ann Thorac Surg (1991) 52:506–513.[Abstract]
  33. Scholz KH, Figulla HR, Schweda F, Smalling RW, Hellige G, Kreuzer E, Aboul-Hosn W, Wampler RK. Mechanical left ventricular unloading during high risk coronary angioplasty—first use of a new percutaneous left ventricular assist device. Cathet Cardiovasc Diagn (1994) 31:61–69.[ISI][Medline]
  34. Scholz KH, Dubois-Rande J-L, Urban P, Morice MC, Loisance D, Smalling RW, Figulla HR. Clinical experience with the percutaneous Hemopump during high-risk coronary angioplasty. Am J Cardiol (1998) 82:1107–1110.[CrossRef][ISI][Medline]
  35. Garatti A, Colombo T, Russo C, Lanfranconi M, Milazzo F, Catena E, Bruschi G, Frigerio M, Vitali E. Different applications for left ventricular mechanical support with the Impella Recover 100 microaxial blood pump. J Heart Lung Transplant (2005) 24:481–485.[CrossRef][ISI][Medline]
  36. Jurmann MJ, Siniawski H, Erb M, Drews T, Hetzer R. Initial experience with miniature axial flow ventricular assist devices for postcardiotomy heart failure. Ann Thorac Surg (2004) 77:1642–1647.[Abstract/Free Full Text]
  37. Meyns B, Stolinski J, Leunens V, Verbeken E, Flameng W. Left ventricular support by catheter-mounted axial flow pump reduces infarct size. J Am Coll Cardiol (2003) 41:1087–1095.[Abstract/Free Full Text]
  38. Meyns B, Dens J, Sergeant P, Herijgers P, Daenen W, Flameng W. Initial experiences with the Impella device in cardiogenic shock. Thorac Cardiovasc Surg (2003) 51:1–6.[CrossRef][ISI]
  39. Henriques JP, Remmelink M, Baan J Jr, van der Schaaf RJ, Vis MM, Koch KT, Scholten EW, de Mol BA, Tijssen JG, Piek JJ, de Winter RJ. Safety and feasibility of elective high-risk percutaneous coronary intervention procedures with left ventricular support of the Impella Recover LP 2.5. Am J Cardiol (2006) 97:990–992.[CrossRef][ISI][Medline]
  40. Dennis C, Carlens C, Senning A, Hall D, Moreno J, Cappeletti R, Wesolowski S. Clinical use of a cannula for left heart bypass without thoracotomy. Ann Surg (1962) 156:623–637.[ISI][Medline]
  41. Pavie A, Leger P, Nzomvuama A, Szefner J, Regan M, Vaissier E, Gandjbakhch I. Left centrifugal pump cardiac assist with transseptal percutaneous left atrial cannula. Artif Organs (1998) 22:502–507.[CrossRef][ISI][Medline]
  42. Glassman E, Chinitz LA, Levite HA, Slater J, Winer H. Percutaneous left atrial to femoral arterial bypass pumping for circulatory support in high-risk coronary angioplasty. Cathet Cardiovasc Diagn (1993) 29:210–216.[ISI][Medline]
  43. Thiele H, Lauer B, Hambrecht R, Boudriot E, Cohen HA, Schuler G. Reversal of cardiogenic shock by percutaneous left-atrial-to-femoral arterial bypass assistance. Circulation (2001) 104:2917–2922.[Abstract/Free Full Text]
  44. Thiele H, Sick P, Boudriot E, Diederich KW, Hambrecht R, Niebauer J, Schuler G. Randomized comparison of intraaortic balloon support versus a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J (2005) 26:1276–1283.[Abstract/Free Full Text]
  45. Burkhoff D, Cohen H, Brunckhorst C, O'Neill WW. A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. Am Heart J (2006) 152:e1–e8.[CrossRef][Medline]
  46. Lemos A, Cummins P, Lee C, Degertekin M, Gardien M, Ottervanger JP, Vranckx P, de Feyter P, Serruys PW. Usefulness of percutaneous left ventricular assistance to support high-risk percutaneous coronary interventions. Am J Cardiol (2003) 91:479–481.[CrossRef][ISI][Medline]
  47. Axelrod JI, Galloway AC, Murphy MS, Laschinger JC, Grossi EA, Baumann FG, Colvin SB, Hunter CE, Glassman E, Spencer FC. A comparison of methods for limiting myocardial infarct expansion during acute reperfusion—primary role of unloading. Circulation (1987) 76:V28–V32.[Medline]
  48. Catinella FP, Cunningham JN Jr, Glassman E, Laschinger JC, Baumann FG, Spencer FC. Left atrium-to-femoral artery bypass: effectiveness in reduction of acute experimental myocardial infarction. J Thorac Cardiovasc Surg (1983) 86:887–896.[Abstract]
  49. Pennock JL, Pae WE, Pierce WS, Waldhausen JA. Reduction of myocardial infarct size: comparison between left atrial and left ventricular bypass. Circulation (1979) 59:275–279.[Abstract/Free Full Text]
  50. Allen BS, Okamoto F, Buckberg GD, Bugyi H, Leaf J. Reperfusion conditions: critical importance of total ventricular decompression during regional reperfusion. J Thorac Cardiovasc Surg (1986) 92:605–612.[Abstract]
  51. Fonger JD, Zhou Y, Matsuura H, Aldea GS, Shemin RJ. Enhanced preservation of acutely ischemic myocardium with transseptal left ventricular assist. Ann Thorac Surg (1994) 57:570–575.[Abstract]
  52. Laschinger J, Grossi E, Cunningham J, Krieger K, Baumann F, Colvin S, Spencer F. Adjunctive left ventricular unloading during myocardial reperfusion plays a major role in minimizing myocardial infarct size. J Thorac Cardiovasc Surg (1985) 90:80–85.[Abstract]
  53. Achour H, Boccalandro F, Felli P, Amirian J, Uthman M, Buja M, Smalling RW. Mechanical left ventricular unloading prior to reperfusion reduces infarct size in a canine infarction model. Cath Cardiovasc Inter (2005) 64:182–192.[CrossRef]
  54. James KJ, McCarthy PM, Thomas JD, Vargo R, Hobbs RE, Sapp S, Bravo E. Effect of the implantable left ventricular assist device on neuroendocrine activation in heart failure. Circulation (1995) 92(Suppl. 9):II191–II195.[Medline]
  55. Torre-Amione G, Stetson SJ, Youker KA, Durand JB, Radovancevic B, Delgado RM, Frazier OH, Entman ML, Noon GP. Decreased expression of tumor necrosis factor-alpha in failing human myocardium after mechanical circulatory support: a potential mechanism for cardiac recovery. Circulation (1999) 100:1189–1193.[Abstract/Free Full Text]
  56. Bruckner BA, Stetson SJ, Perez-Vardia A, Youker KA, Radovancevic B, Connelly Koerner MM, Entman ME, Frazier OH, Noon GP, Torre-Amione G. Regression of fibrosis and hypertrophy in failing myocardium following mechanical circulatory support. J Heart Lung Transplant (2001) 20:457–464.[CrossRef][ISI][Medline]
  57. Dipla K, Mattiello JA, Jeevanandam V, Houser SR, Margulies KB. Myocyte recovery after mechanical circulatory support in humans with end-stage heart failure. Circulation (1998) 97:2316–2322.[Abstract/Free Full Text]
  58. Taylor K, Bain WH, Davidson KG, Turner MA. Comparative clinical study of pulsatile and non-pulsatile perfusion in 350 consecutive patients. Thorax (1982) 37:324–330.[Abstract]
  59. Finlayson D. Con: nonpulsatile flow is preferable to pulsatile flow during cardiopulmonary bypass. J Cardiothorac Anesth (1987) 1:169–170.[CrossRef][Medline]
  60. Shevde K, DeBois W. Pro: nonpulsatile flow is preferable to pulsatile flow during cardiopulmonary bypass. J Cardiothorac Anesth (1987) 1:165–168.[CrossRef][Medline]
  61. Hochman JS. Cardiogenic shock complicating acute myocardial infarction. Expanding the paradigm. Circulation (2003) 107:2998–3002.[Free Full Text]
  62. Kirklin JK, Westaby S, Blackstone EH, Kirklin JW, Chenoweth DE, Pacifico AD. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg (1983) 86:845–857.[Abstract]
  63. Hall RI, Smith MS, Rocker G. The systemic inflammatory response to cardiopulmonary bypass: pathophysiological, therapeutic, and pharmacological considerations. Anesth Analg (1997) 85:766–782.[CrossRef][ISI][Medline]

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